Hair Restoration Blog

Q:

Quick question for you doc.

I was wondering, will I need to buzz off all my hair before a hair transplant surgery? It really doesn’t matter, but I just want to know what I’m getting into. I imagine that my remaining hair, while very thin, obscures the scalp too much for comfort.

A:

You do NOT need to buzz off your hair before a hair transplant.

While some patients with significant miniaturization of their existing hair may be asked to cut it short or clip it, we typically are able to do this in office before the procedure if they are OK with it. Clipping hair is not mandatory in any way. However, it may increase our precision in some patients and we do it for them only if they have no problem with having very short hair for a while after hair transplant.

The growth cycle of hair follicles differs between each individual.  For that reason, transplanted hair grafts also may not follow a universal pattern.  We generally schedule follow up visits for our hair transplant patients on the day 1, day 10, month 5 and month 10 following their hair transplant surgery.  Our five month follow up is to make sure patients are having a smooth early growth without any problems or complications.  In most cases, early growth is seen at five months post op.   In some people who started growing hair earlier we may even see something close to their final result.  However, we have had some cases that we did not see impressive results at month five and patients experienced delayed growth of their transplanted grafts following the procedure.

Delayed hair growth after After a hair transplant procedure - Class VI baldness - Before (left), five months (middle) and ten months (right) after hair transplant with US Hair Restoration

Most of these patients do not have anything wrong with their transplanted hair and will only have to be more patient with their hair growth.  We bring all hair transplant patients back in month 10 after their surgery and the results at that time are much better.  This group of patients may see their final result more than 10 months from the time of their hair transplant and it may take 12 to 18 months to see full result.  If the results are still poor at month 10, more diagnostic tests such as a scalp biopsy may be needed to rule out other causes of hair loss that might have been involved with the growth of their transplanted hair.

There are several studies that suggest ketoconazole (Nizoral Shampoo) to be beneficial for men with male patterned baldness.  Ketoconazole has been compared with minoxidil in a research in 1998 that (ketoconazole 2% vs.  minoxidil 2%  in men with typical male patterned alopecia.  The study indicated improvement of hair density and growing hair with both medications.  Both 1% and 2% solutions and shampoos reported to benefit patients with male patterned hair loss.  The shampoo however needs to stay on scalp for at least 3 to 5 minutes before it is rinsed, which is not always easy in our today’s life.  Ketoconazole shampoo is used for treatment of seborrheic dermatitis or hair dandruff.

At this time, Nizoral Shampoo is not FDA approved for the treatment of hair loss and thus is not endorsed for this purpose for public.  We recommend finasteride for most men with active male patterned hair loss which has higher potency for correcting male patterned balding in comparison to minoxidil.  For more information on this topic, please visit our page discussing minoxidil vs. finasteride for hair loss.

Using hair from other parts of the body for transplantation into scalp has been used for many years.  Unfortunately though, the change in the life cycle of body hair from different areas of the body has caused the body hair to stay as the last option for scalp hair restoration.  Body hair has long resting phase and short growth phase which means that most of the transplanted hair will stay in resting phase without having visible hair growth.

Comparison of scalp (left) vs. facial (right) hair: Note the difference in density of hair per surface area and the average number of hair in each follicular unit. Scalp hair is denser with more hair per grafts (over 2hair/graft) while beard hair is less dense with fewer hair per grafts (1-2 hair/graft)

Facial hair such as beard and mustache hair on the other hand has a longer growth phase and shorter resting phase.  That is why men can grow their facial hair to become really long.  Facial hair is also thicker than scalp hair in most people.  Thicker hair could be translated as more bulk of hair after hair transplantation.  Both longer growth phase and thicker hair shafts make beard hair a better option for scalp hair restoration in comparison to body hair transplant from other areas.

There are two problems with with beard hair restoration.  One is that they are very sparse and removing hair only needs to be done through a strip procedure.  The other problem with using facial hair for scalp transplant is that the facial follicular units are having fewer number of hair per unit that means less hair per grafts removed with FUE techniques.

Beard transplants are gaining popularity recently with newer techniques for extraction of hair (FUE) and it can be a great alternative to scalp hair for transplanting to the balding area in people who do not have good quality scalp hair.

Below are some responses to a few basic questions we received from a patient online:

How many grafts/hairs would I require for a good restoration? Could you please point to some examples.

Although for most cases with only frontal hair loss we recommend 1500-2000 grafts on average, your personal recommendation can be above or below that number depending on your eligibility, extent of balding area, history, donor density and scalp laxity.

An example of a female who received 1609 grafts with us can be seen here: http://www.ushairrestoration.com/hairrestorationbeforeaftergallery-view.php?album=93

What is the cost for hair transplants (including everything – procedural cost, fees, everything)? I understand you will not be in a position to get me the exact figures without a personal meeting but I need to have some rough idea to estimate my costs.

A hair transplant procedure performed at US Hair Restoration is calculated based on the number of grafts recommended to you. To determine what is recommended for your specific case, we recommend attending a free consultation with Dr. Parsa Mohebi at your earliest convenience. To view additional information on our general hair transplant costs please visit our hair transplant cost page.

There are times that US Hair Restoration offers Standby Rate discounts available to those with flexible schedules for booking the procedure.  Our stand-by option can offer you an additional discount (for discount rates and availability of this option please call 1-888-302-8747). You can also use our financing option in addition to that for your hair restoration.

Can the whole procedure be done in one sitting?

Yes. Overall, most hair restoration procedures performed by at US Hair Restoration will be completed in one day.  Occasionally patients may need more density that is not possible to create in one session or they have extensive hair loss that requires more than one hair transplant session.

Does FUE still have shock loss risks?
Yes, regardless of the technique of harvesting hair we recommend some sort of medication to prevent shock loss after hair transplant surgery.

In regards to your in-depth questions on exact number of grafts, donor hair growth, care after hair transplant, etc:
I recommend calling to schedule a free 30-60 minute consultation in which we can explain more detailed information to you personally and recommend an accurate number of grafts for your specific case.

Q:

Hello, I have a question, can you please help verify the answer to this. I am really stressed out regarding the situation. I can’t ask my doctor because he is on vacation for the next month.

I was prescribed propecia for hairloss, but I am reluctant to take it because of hyperandrogenicity from finasteride. Is there any truth to that? is there a chance that a person can develope hyperandrogenicity from taking propecia and making a persons hair loss even worse. By the way I also have acne, and I am scared that the hyperandrogenicity can make my acne worse and skin more oily.

Please help me. Can propecia(finasteride) cause hyperandrogenicity, or is it not true. Can the increase in testosterone from propecia cause more hairloss and make the situation even worse.

thanks in advance

A:

Finasteride (Propecia) is a 5 alpha reductase inhibitor. That means that it blocks the enzyme that converts testosterone (male hormone) to Dihydrotestosterone (DHT) in the body. The main cause of baldness is DHT and not testosterone in addition to having the gene of hair loss. When first getting started on Finasteride, some men may even have an increase in their testosterone levels because it is no longer being converted to DHT and therefore its levels goes up. However, please be aware that these changes are temporary. Some men may feel an increase in sexual urge due to the increased testosterone for a few days but it is temporary. Since testosterone does not directly cause hair loss and its effect is due to the production of DHT, elevation of DHT should not worsen your hair loss in any way.

The increase in testosterone levels can affect your acne. I am not sure how significant the slight elevation of the testosterone could be on your acne and for that you need be seen by a dermatologist.

Q:

Hi doc?  could Rogaine foam have adverse effect on hair transplant result? some say it helps for hair growth, some say it does not add to hair growth, but have you seen any where saying it might prevent hair growth on men with hair transplant? thanks.

A:

Rogaine (minoxidil) can be used after hair transplantation (only on the newly transplanted area) to protect the native hair and not to promote the growth of transplanted hair. Transplanted hair does not need any medication to promote permanence or grow and if chosen correctly it is considered to be a permanent hair loss solution. I personally recommend Propecia to protect patient’s existing hair against shock loss (losing native hair) after hair transplant on men. It is proven that this medication works better than Rogaine for shock loss prevention and has had remarkable results in those patients who have used it as directed. Women cannot use Propecia and I tend to offer them Rogaine as an alternative for the few months following their hair restoration.

Hi everyone,

I had a somewhat funny call to me the other day from a past patient of mine and wanted to share his experience with this blog. Although we, at US Hair Restoration, are known worldwide for our quality results and affordable prices, there are some downsides to the remarkable effects that your hair restoration may bring you without prior notice.

One of our patients called over to our office the other day laughing and telling our front desk receptionist that his passport photo looks NOTHING like him. He was traveling out of the country the following day when he had glanced at his photo and realized that the previously taken photo in no way resembled his current image. He called to request that I write a general letter confirming his procedure in the event that there were any discrepancies in his change of appearance.

We would like to apologize in advance for any unexpected changes in your appearance that may make you look years younger or like a different person following your hair transplant procedure. We are 100% proud of our patient results and happy to hear that if nothing else, these are the only few negative aspects of a hair transplantation with US Hair Restoration. We thank our patient for the great laugh and hope that he made it through customs without a hitch!

Q:

Where can I see Dr. Mohebi’s before and after photos? Would Dr. Mohebi be doing the hair transplant surgery himself? How are the donor hairs relocated once broken down into follicular units? Do they just get shoved into place? Am I completely out during the procedure or awake? How long before I don’t look like I just dove into a pool full of needles? Can you send me a link to you’re site if you have one. Thanks so much!
A:

Here is the answer to your questions:
Before and after photos could be seen in our hair transplant photo gallery that we try to keep updated with the new pictures on a regular basis.

Would Dr. Mohebi be doing the hair transplant surgery himself?
Yes, at this point all surgeries will be performed by Dr. Mohebi himself.  A surgical team will assist the doctor during the dissection and implantation of hair follicular unit grafts.

How are the donor hairs relocated once broken down into follicular units?
We transplant the hair grafts or follicular units based on the need of a patient. The doctor will draw the hairline before surgery and discuss it in detail with the patient.  Hairline designing has to do with the degree of baldness in each area and patients preferences.

Do hair grafts just get shoved into place?
The follicular units need to be maintained in special solutions in sold temperature while they are out of the body.  When the sites are made, we insert the grafts gently into them one at a time.  This process is very meticulous and usually takes a few hours.

Am I completely out during the procedure or awake?
You will be sedated, but you will not be totally out.  You will become more alert during the surgery in which you are sitting in a surgical chair most of the time.  You can be watching a movie, listening to the music or reading a book during your hair transplant surgery.

How long before I don’t look like I just dove into a pool full of needles?
You will probably never look like that, but if you are concerned with redness and swelling after surgery they may last a few days.  Most patients recover from surgical swelling and redness after the first 4 or 5 days.

Diffuse Unpatterned Alopecia (DUPA) is a hair loss condition in which hair thinning is seen diffusely throughout the scalp.  In DUPA, there is no a reserved area with good quality hair even on the areas of the back and side which are typically designated as the donor area in hair transplant patients.

A microscopic evaluation of the scalp generally shows significant miniaturization (fineness) of scalp hair diffusely.  DUPA can be seen in both men and women but its female type may at times be mistaken with typical female patterned baldness due to its close similarities.

A thorough medical evaluation with supporting lab work to rule out other causes of diffuse hair loss is always warranted before determining eligibility for a hair restoration procedure.  Hair transplantation is generally not a good option for people who have DUPA due to instability of the scalp hair on the back and side areas of the scalp.  Many people who have DUPA may suffer from other medical conditions that cause hair loss such as Iron Deficiency, thyroid or other hormonal imbalances or autoimmune disorders.  Medical treatment such as minoxidil in women and finasteride in men could be helpful in treatment of this condition.